HomeMy WebLinkAbout10-18-78 (2)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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RESIDENT DECEDENT
COUNTY OF
Cumberland
IMPORTANT:
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re\tenue. (Section 703 of the Inheritance and Estate Tax Act cf 1961.)
IN 8:E MATTER OF THE ESTATE OF
Alice K. \vertz
(STATE FULL NAME OF DECEDENT)
Late of
CumberJana
} AFFIDAVIT OF
EXECUTOR
1\'mdltl130UCmmc
County
State of Pennsyl vania
}.
County of C1JmbeT'lann
~1Kt'IUOK
E. Nae Wertz
Executor
of the estote of the obove-named decedent being duly sworn, depose
and say
Decedent died
July 20.
(MONTH)
Name and oddress of attorney or }
other authorized representative to whom
011 correspondence should be mailed.
(DAY)
, 19---.ItL{testate leaving a last will, copy of which is hereto'attached. }
(YEAR) i~X
J. Robert Stauffer-Market Square Bldg.,
Mechanicsburg, Penna. l705~
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
( EX E CU TO R-ADMIN I ST RA TO R)
the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exception of the following: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
None
N/A
That the contents of said safe deposit box or boxes are itemized under Schedules of this return,
wi th the exception-of the following, for the reasons hereinafter set forth:
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate pos session, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
gi ving al so separately the accrued interes t thereon, if any, down to the las t interes t day priCOf to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, ,whether by stat~te or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever. kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interes t thereon to the date of decedent's
death and other inve stment securi ti cs owned by the decedent at the time of death, with the market value there-
of at such time.
In the case of secul'ities of close or family corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death in any co-partnership or business, and in support of the value of such interest t'1ere is Ilnnexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or business.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the df>cedi.,nt's interest
therein must be submi tted. It should also set forth in itemized form, together with tlle flli I' mar'ket value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer t.o each inquiry
contained therein and in t.he case of transfers of property, real or personal, within two years of decedent's
death, in contemplat.ion of decedent's death, or intended to t.ake effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom t.r~sferred, the
relationship of the transferees to the decedent, t.he proportionate share received by each transferee and
all ot.her facts of a pert.inent nature regarding said transfers. In the case of transfers intended to
take effect in possession or enjoyment at or after death, there is also at.tacherl to the scherlule a cony
of the deed, trust agreement or other instrument creating the trust. There is alio set fort.h in said
schedule a list of' all property, real and personal, with its value, which passes at decedent's death by
virtue of the exercis.e by decedent., either individually, or jointly with ,another, or any power of appoint-
ment. vest.ed in decedent, either individually or joint.ly, by t.he will, deed, or other inst.rument oC another,
wit.h a copy of t.he instrument. creating such power attached to the schedule.
That Schedule D att.ached heret.o and made part hereof set.s forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the n~ture of' their res-
pective interests, their relationship, if any, to the decedent, together wit.h the ages at the time of
decedent's deat.h of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a stat.ement. showing which of the beneficiaries named in the decedent's will, if any, died prior
t.o decedent, the dates of their death, their issue, and the relationship of such issue to t.he beneficiary.
That Schedule E attached hereto and made a part. hereof sets forth all property, real and per-
sonal, owned by the decedent ,jointly wi t.h anot.her or others, including intangible, standing in the name
of the decedent and others, plus the date and place of record of instruments effecting the vesti ture of
real est.ate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Schedule F at.tached hereto and made a part hereof sets fort.h fully and in det.ail all debts
and deductions claimed for ann on behalf' of this decedent's estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and t\ldiciary's
commissions paid or t.o he paid; cost expended for burial trusts, t.ombstones or gravemarkers, and reli-
gious services, in consequence of t.he death of t.he decedent.; debts and claims owing and unpaid at t.ime of
death; t.axes accrued chargeable for period prior to decedent's death (except t.hose allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
t.ions, if any. It is agreed that t.he fiduciary will present proof of said claimed obligations upon re-
quest., that if the amount act.ually paid in settlement of any fee, commission or debt is less than the
estimat.ed amount cl aiming and allowed, that the same will be reported to the Regist.er of Will s, and that.
the amount of tax assesse(l can be reassessed in accordance therewith.
That the t.otals of' the appropriate columns in Schedules "A", "B", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this
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...18,. ...E.........Gr..e..~.n.....s..t.....................................................-..............
(Street Number)
..e h:i.r.E?P.l:?:P..~.~.9w.D..J......:r.~.QD.?:..! ... .:L7Q.:L~.
(City or Town and State)
day of . C(<:{;.J..tL
...........19.....7.$..
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NOTE: Before signing affidavi t make sure all blank sp~ce~ in the affidavit anrl schedules annexed are
filled in with det.ails or the word "None", and in case t.he'asset.s include rare and unlistect securities,
securities of close or family corporations or an int.erest in any co-partnership or business, that the
data and stat.ement.s requirect under the paragraph above relating to Schedule "B" are attached. Also make
certain that coltmm #1 in the "Surmnary" has been properly completed as above-directed.
..
RCC-34 (....73) .
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "Aft
REAL PROPERTY
*'
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent 9S tenant.in common with another. or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule liE.")
The real property located In the Commonwealth of Pennlylvanla .hould be
de.crlbed by lot and block number, .treet and Itreet number, together with
a general description of the property, with a reference to the record of the
conveyance by which the decedent took title; If a farm .tate number of a.
ere.; 01.0 .tatement of mortgage encumbranc.. upon each parcel at death
of decedent. Taxe., a.....ment., accrued Intere.t on mortgage., etc.,ar.
to be II.ted on Schedule II F" and mu.t not b. deducted from thl. .chedule.
(1 )
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEA TH
ALL THAT UNDIVIDED one-half interest in and
to a certain House and Lot of Ground situat
in the Borough of Shiremanstown (on the
South side of Green Street), Cumberland
County, Pennsylvania, bounded and described
as follows, to wit:
BEGlm~ING at a point in the curb line of
said Green Street and the line of land now
formerly of H. C. Hendricks; thence Southwa
along said line, 200.00 feet to an Alley;
thence along the line of said Alley, Westwa
30.00 feet to the line of land formerly of
John Maxwell, now or formerly of Frank E.
Weber; thence along the line of said land
now or formerly of Frank E. Weber, Northward
200.00 feet to the curb line of said Green
Street; thence along the line of said Street
Eastward, 30.00 feet to the place of BEGINNI G.
,
HAVING thereon erected a two (2) story frame
dwelling numbered 18 East Green Street,
Shiremanstown, Pennsylvania.
BEING the same premises with G. J. Wertz and Fay
Wert~, his wife, by their Deed dated June
18, 1932 and recorded in the Cumberland
County Recorder's Office in Deed Book "H",
Volume 11, Page 293, granted and conveyed
unto Alice C. Wertz and E. Mae Wertz.
The above deed of conveyance created a
tenancy in common, thus vesting an undivided
one-half interest therein in the decedent,
Alice C. Wertz.
,-,j.(
The subject property is assessed at $2730.00
for 1975 Tax purposes and based thereon it
estimated that the market value._~f '.i(PSlt)"" ,
property is currently tl2.,.QOO ..00 and deceden 's
interest being one-half thereof or $6,000.00
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not wr It.
In th I. .pac.)
ESTIMA TED
MARKET VALUE
? /0:.1,;7"
1 500.00
J
~.~~~. 00
1, soo,eo
,
Rec -35
RESIDi::Nf DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
A~'
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COMMONWEALTH OF PENNSYLVANIA
TRANS~~R INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and ~lrnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or diVidends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in any undis tributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No. List and describe fully VALUE MARKET VALUE (Do not write in
this space)
None - See Schedule 11,.,11 herein. None N cr\L
-'-'
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I
I
Insert this total opposite "Personal Proper ty" , Schedule "B" in X X N Of\L
None
the "As Reported" column on the last page of this return.
..
RCC-36
COMMO;.,WEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRA.NSFERS
RESIDENT DECEDENT
(1) Did decedent, within two years of death, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) No
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) No
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer None
(b) State of decedent's health at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no)_____N~
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no) No
(b) What was the transferee's age at time of decedent's death? None
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) No
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others None
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) No
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) No
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) No
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death certificate.
NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with
relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
See Schedule nEn herein...
None
NOt'll
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
None
N OnL
...
RCC~37 (1,2-63)
l'm'I\IO~\\'EALTIl OF PE;\;:\SYYL\NIA
TRANSFER INIIERITAl\'CE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BE:\"EFICIARIES
BENEFICIARIES AND ADDRESSES RELA TIONSHJP I
(If step-children or Sl!RYIVED DATE INTEREST OF
State full names and addresses of all who illegitimate children I DF,C~'-~EN,T OF BENEFICIARY
ave an interest, vested, contirrgent or other- are involved, set STA1E YES BIRTH IN ESTATE
wise, in estate). forth this fact.) I OR NO
I Entire Estate
"R MA.e Wertz Sister Yes !
18 E. Green Street
Shiremanstown, Penna. 17011
--
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Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
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(2)
(As ))I'tl'nllincr! )
SUMMARY
(Sch. "A")
. (Sch. "B")
(Sch. "C")
Heal Property
Personal Property
Transfers
.Join tlyOwnedPropert"y (Sch .1I"8")
Gross Taxable Estate
( 1 )
(As Reported)
$ 6000.00
$ 0.00
$ 0.00
$29036.93
$
$ 35036.93
$
$
$
$
S
$
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RCC-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This scherlule mus t disclose all property, real and personal, owned by the rlecedent jointly
wi th another or others, including intangibles, standing in the name of the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief description, as indicated Imder Schedule
"A", pluS the date and place of record of instrwnent effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "8", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name unit percentage Estate
Address and Relationship of Co-Owners, and Place Value Share Valuation
of Record of Instrwnent, where Real Estate.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
^
y
Value of
Entire
Property
Value of
Decedent's
Interest
(1) Checking Account No. 162-952127-7v
with The Commonwealth National Banl ,
registered in the names of Alice C
Wertz or E. Mae Wertz. Balance as
of July 20, 1978 was $2,292.94.
Opened as a Joint Account on
July 19, 1971.
(2) Evergre~ Savings Account No. 16-
0010251-9 with The Commonwealth
National Bank, registered in the
names of Alice C. Wertz or E. Mae
Wertz. B!lance as of Ju1y,gO~ r
1978 was ,+,6,510.52 V' .>' ~--~,
Accrued interest 7/20/78 $16.65.
Opened as a Joint Account July 19,
1971.
Principal -
Interest -
( 3) Certificate of Deposit No. 16-10881/
issued in the principal amount of
$7,000.00'bearing interest at the
rate of 7.250% per annum, register~d
in the names of E. Mae Wertz or
Alice C. Wertz, dated March 20,
1976. Interest accrued to July
20, 1978, was $42.~2.~-
Principal -
Interest - ~
(4) Certificate of Deposit No. 16-118~
issued in the principal amount of
$10,000.00 bearing interest at the
rate of 7.0c% per annum, registere
in the names of E. I'1ae Wertz or
Alice C. Wertz, dated Oct. 4, 1976
Interest accrued to 7/20/78 was
$31.16.
Principal -
Interest -
(5) Six Hundred Thirty-six (636) share~
of common stock of Warner-Lambert
Pharmacuetica1 Company, all registered
in the names of 11iss AlIce C. Wertz &
)vIiss Ellen I'1ae Wertz, as Joint Ten~nts
with the Right of Survivors~ip, aS~8 7'~ ~o%
follows:', F-:_~~""D;;} I'
Cert. No. N067916 dated 12/30/57 for - 1 share
Cert. No. N020318 dated 12/30/55 for - 1 share
Cert. No. N042527 dated 1/15/57 for - 1 share
Cert. No. NOl13825 dated 6/10/59 for - 53 shares
Cert. No. N0176666 dated 6/12/62 for - 12 shares
Cert. No. N127B95 dated 6/12/62 for - 100 shares
Cert. No. N127896 dated 6/12/62 for - 100 shares
Cert. N~. 10109lJ. date<;l "/7/C;'~/:t;Qr ~ ..,c;g shhares
CA:;"f: 1\1(, ;-) It '( "),' q~ rI Q r:P'(l' 6jl0/ (~ for - ~1 s ares
50Jb
1146.47;v
\ \ ~l.o. "n
)
5 Cf}s
I,
5OJo
3255.2~
~ 8 1 I
.,
.9, ~.s5. do ~
q.'!~
Jf
I -
50%
50%
3500.00 v
21 .21 /
3\500. O~
~I. ~l
100;&
100;&
0000.00
31.16
lO 060. 00
I
31. ,,-
\. I r (
~ ~.. . .1
9, ~~\.~S
9142.50
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R C C-38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
wi th another or others, including intangibles, standing in the name of the decedent and others. List
real estate f.irst, as entireties, or joint tenants, giving brief description, as indicated lmder Schedule
"A", plLs the date and place of record of instrument effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisi tion, Name uni t percentage Estate
Address and Relationship of Co-Owners, and Place Value Share Valuation
of Record of Instrument, where Real Estate.
"'.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
property Interest
BaQTT\;HT FOl1.1'ltJRD
----
----
t?719~.~
(6) Sixty-four (64) shares of common
stock of American Telephone and
Telegraph Company, registered in
the joint names of Miss Alice C.
Wertz and Miss E. ~ae Wertz, as
Joint Tenants with the Right of
Survivorship, as follows:
\ . ,ll~" (
60- 3/8 50;0
,oc
1932.00
')q a &t. 00
Cert.
Cert.
Cert.
Cert.
No. 64XB244808 dated 6/1/64 for .
No. 6J+R201849 dated 3/9/64 for .
No. 30-013560 dated 1/20/60 for.
No.J388487 dated 4/6/61 for -
32
1
30
1
shares
share
shares
share
Insert this total opposite "Jointly Owned Property", SChedule"~ ~
in the "As Reported" colurrm on the last page of this return. "~036.;
SCHEDULE: "E" - PAGE "2"
~~\ ~ 39. \~
REv-eta (a.78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIO~S
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
.
Inheritance Tax Division
~OTICE OF FILING OF APPRAISEMENT
E. Mae Wertz
18 E. Green St.
Sv;rpm~n~tnwn, PA 17011
(Executor or Adm ini strator)
In Re:
C.
Estate of ~~_'d.e.r.t.Z-
C11mberland
County - File No. 21-78-0428
Dear
You are hereby notified that the Original
appraisement in the estate of Alice ~ Wertz
has been filed in the office of the Register of Wills of Cumberland
County on 26 T~n11~ry , 19~, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
7.500.00
None
None
29.239.18
36.739.18
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22,1965 to June 16,1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
Date 26 January 79 Signed '\-e-o ~ ~ ~
()
Title Administrativp Off; t'pr
{ -------.-
Note: This is not a bi II.
R C C-2 (2-64)
'DEPARTMENT OF REVENUE
BUREAU OF' COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE 26 J~nll~ry 7q
COUNTY Cumberland
FILE NO. 21-78-0428
Whereas, Alice 2.- Wertz late of Rnrnl1gh nf Sh; r~mal1~tQw:El.
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 20th day of Till y 19-IB-, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, le9 F\:llgiaiti , an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit Appraisement
Description of A..et Value. Made for Inheritance
Tax Purposes
$ : nn
R~al F.!':r,qrp 4-500
Personal Pronertv None
Transfers None
Tn; nr1 '\7 OtJn"'r'I ?q ?':lQ 1 Q
Total 'U; 7~q lA
-
Having been duly sworn according to law, I do hereby certify that the above appraisement is made in con-
formity with law on this 26th day of Je~~; ~', 19--19-'
_..:__ \- t~ ~
< ) Appraioer
(N'umber and Stroot)
Harri!':hllrg
(Poft 0fII".)
, Penna.
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